CMMI Considers New Value-Based Payment Model for Oncology Care

Last year, the Centers for Medicare and Medicaid Innovation (CMMI) released a Request for Information as it sought comments for its Oncology Care First (OCF)  proposal, a voluntary model open to physician groups and hospital outpatient departments offering two payment mechanisms. Now it is considering the addition of clinical laboratory services to bundled payments in its proposal.

“The inefficiency and variation in oncology care in the United States is well documented, with avoidable hospitalizations and emergency department visits occurring frequently, high service utilization at the end of life, and use of high-cost drugs and biologicals when lower-cost, clinically equivalent options exist,” the CMMI RFI states

In addition, the RFI states the consideration of services such as imaging or medical laboratory services in the OFC’s monthly population payment. In a letter to CMMI Acting Director Amy Bassano, Cynthia Bens, Personalized Medical Coalition senior VP for public policy, expressed her concerns:

Laboratory services are crucial to the diagnosis and management of many cancers and are an essential component of personalized medicine. We are concerned that adding laboratory service fees to the MPP may cause providers to view them as expenses that are part of the total cost of delivering care, rather than an integral part of the solution to attain high-value care.”

Weighing in on the value-based model, Bens called on CMMI to connect with laboratory and provider communities to construct the best way to contain costs within the model.

The agency also proposed a controversial Radiation Oncology alternative payment model to be implemented in less than for months for practices in randomly-selected metro areas. CMMI estimates that it would apply to about 40% of the radiotherapy practices in the U.S. The five-year model would make prospective payments to cover radiotherapy services for patients diagnosed with cancer.

For more on the proposal, check out Dark Daily.

Also, take a look at the RFI here.

And for more on the OFC model, check out The Flatiron Blog.